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Benign conditions of the lower urinary tract, including benign prostatic hyperplasia, overactive bladder syndrome, and stress urinary incontinence, are frequent in the general population. Despite their benign nature, they have major adverse effects on the quality of life of the afflicted patients and their partners. Despite major progress in the diagnosis and treatment of these conditions, improved understanding and management of these patients remain substantial medical needs. This editorial discusses some recent high-quality articles published in the Journal of Clinical Medicine on the understanding of the epidemiology, pathophysiology, diagnostic, and treatment of benign diseases of the lower urinary tract tissues such as the bladder and prostate.

To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...] [ABSTRACT FROM AUTHOR]

Benign conditions of the lower urinary tract, including benign prostatic hyperplasia, overactive bladder syndrome, and stress urinary incontinence, are frequent in the general population. Despite their benign nature, they have major adverse effects on the quality of life of the afflicted patients and their partners. Despite major progress in the diagnosis and treatment of these conditions, improved understanding and management of these patients remain substantial medical needs. This editorial discusses some recent high-quality articles published in the Journal of Clinical Medicine on the understanding of the epidemiology, pathophysiology, diagnostic, and treatment of benign diseases of the lower urinary tract tissues such as the bladder and prostate. [ABSTRACT FROM AUTHOR]

Introduction: The fund of knowledge on benign prostatic hypertrophy (BPH) has been growing since the 1970s. Citation analysis is a tool by which we can quantify influence of specific articles and assess the growth of a certain topic. This paper seeks to identify trends, as well as draw attention to the most influential papers, authors, and journals. Many analogous studies have been done, but none have been done in the field of BPH. Methods: We used Thomson Reuters Web of Science to collect articles pertaining to BPH in a two-step fashion. We identified 117 keywords relevant to BPH and using these 117 words, we were able to identify 7302 total articles. These articles were organized by number of citations. Of the top 200 articles, 100 articles were excluded based on title and abstract analysis. One hundred articles were included for final analysis, as this is the standard of citation analysis. Results: Overall, total citations were slightly correlated with journal impact factor. Author analysis revealed no significant difference between authorship and average citations. Topic analysis showed the most cited topic was surgical management with 657.35 citations per year. Study design analysis showed the predominant study design was the randomized control trial. Conclusions: By using the two-step methodology, we were able to create a list of the top 100 most influential articles in the field of BPH. In doing so, we illustrated the growth of the field over time and paid tribute to the myriad of papers, authors, and journals that have shaped the field to this day. [ABSTRACT FROM AUTHOR]

Finasteride is used to treat benign prostatic hyperplasia (BPH) and pattern hair loss (androgenetic alopecia or APA). The local administration of formulations with increased solubility and controlled release of finasteride are proposed using gallate-containing compositions within embolic microparticles or paste. Finasteride solubility in either epigallocatechin gallate (EGCG) or tannic acid (TA) solutions was assessed using HPLC. Poly(dl -lactide- co -glycolide) (PLGA) or poly(methylmethacrylate) (PMMA) microspheres (100–400 μm) containing finasteride and EGCG or TA were effectively manufactured. Embolic particles were loaded with finasteride/EGCG/TA. Dermal uptake of TA/EGCG/finasteride topical compositions was measured in pig skin. The solubility of finasteride was dramatically increased using EGCG- or TA-based compositions. Finasteride loaded microspheres released over two months which was increased by EGCG or TA inclusion. Embolic particles soaked up finasteride and EGCG or TA and released the encapsulated drug over two weeks. Dermal uptake of finasteride from EGCG- or TA-based formulations was enhanced between 10 and 50 fold in layers as deep as 500 μm when compared to a generic control formulation. Gallate-based formulations of finasteride increase drug solubility and allow for effective release of the drug from embolic formulations. Paste or powder EGCG- or TA-based formulations of finasteride greatly increase dermal penetration of the drug. [ABSTRACT FROM AUTHOR]

Background Finasteride is approved treatment for androgenic alopecia and benign prostatic hypertrophy. It may have an effect on sperm, however the data is lacking. Few published papers described the association between 1mg/day of finasteride treatment for androgenic alopecia and sperm. Objective Reviewing all articles describing the association between treatment of finasteride (1mg/day) for androgenic alopecia and sperm concentration. Methods Comprehensive literature review using PubMed as a search engine from 1980 till present. Main outcome measures: Sperm concentrations during treatment and after treatment are the main outcome measures of this analysis. Results Seven papers were found on PubMed using the mentioned keywords on the management of androgenic alopecia giving a total of 113 subjects in all papers. No baseline sperm concentration was measured except for one paper. All papers but one (n=22) showed increase in sperm concentration after cessation of finasteride. However, the largest study (n=91) had baseline, during and post treatment measurements of sperm and showed no change in sperm concentration level. Conclusion The analysis of reviewed papers showed that long-term treatment with finasteride is safe on sperm concentration. However, there are some signs of short-term effect during treatment. [ABSTRACT FROM AUTHOR]

Abstract: We report the technical recommendations of the International GreenLight User Group on photoselective vaporization of the prostate in men with benign prostatic hyperplasia using the GreenLight HPS system (American Medical Systems, Minnetonka, Minnesota, USA). This high-power system employs a 120-W laser, which is a modification of the previous 80-W potassium-titanyl-phosphate (KTP) laser. The objective of this report is to optimize the efficacy and safety of the procedure by drawing on the experience of this multicentre international group. In this regard, recommendations for training are made, which relate to existing users of the 80-W KTP laser as well as to new laser users. [Copyright &y& Elsevier]

Introduction and aim. Benign prostate hyperplasia is the common health problem in ageing male. Reactive oxygen species are produced more with advancement of age leads to oxidative stress. Oxidative stress may lead to compensatory cellular proliferation with resulting prostate tissue damage and hyperplastic growth. The purpose of our study was to determine markers of levels of the oxidative stress in urine of patients with benign prostate hyperplasia. Material and methods. 54 men with benign prostate hyperplasia and 65 healthy men as a control group were included. We determined the urine levels of advanced oxidation protein products (AOPP) and malondialdehyde (MDA). Results. In our study, we noted a statistically elevated level of AOPP, one of the most frequently estimated markers of protein oxidative modification in urine of patients with benign prostate hyperplasia (25.6±14.8 vs 15±8.6 μmol/mmol creatinine, p<0.001). Moreover, the concentration of MDA in the urine was significantly increased in men with benign prostate hyperplasia compared to controls (1.18±0.55 vs 0.84±0.18 μmol/mmol creatinine, p<0.001). Conclusion. Our study showed the evidence of association of oxidative stress in patients with benign prostate hyperplasia. [ABSTRACT FROM AUTHOR]

Objectives: To identify the cooperation of authors, countries, institutions and explore the hot topics' prospects regarding research of prostate diseases and erectile dysfunction (ED). Methods: Publications on research of prostate diseases and ED were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using VOSviewer and CiteSpace software. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Results: A total of 2,599 articles related to study of prostate diseases and ED were identified. We observed gradually increasing in the number of publications from 1998 to 2016, and the trend was to be relatively stable in the past 3 years. Journal of Sexual Medicine (243 papers) owned the highest number of publications and Journal of Urology was the most co-cited journal. Mulhall John P (52 papers) was the top most productive authors and Mcvary Kebin T with the largest numbers of citations (1,589 co-citations) during the past decades. There were active collaborations among the top authors. The USA was the leading contributor in this field with 1,078 papers. Active cooperation between countries and between institutions was observed. The main hot topics included matters related to erectile dysfunction, prostate cancer, quality-of-life, radical prostatectomy, sexual function, and BPH. Conclusion: Bibliometric analysis provides a comprehensive overview of the development of scientific literature, allowing relevant authors and research teams to recognize the current research status in this field and at the same time provide a reference for formulating future research directions. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a common urological disorder leading to dysuria in middle-aged and elderly men and significantly reduces the quality of life of patients. Technology for BPH has made a great progress, while there is still a lack of visual and summary literature to make the summary. Summary: The aims of the study were to identify the cooperation of authors, countries, institutions, and explore hot topics' prospects regarding research of BPH. Relevant original articles were obtained from the Web of Science (WoS) database between 2016 and 2022. CiteSpace software was used to perform the analysis and visualization of scientific productivity and emerging trends. Key Messages: A total of 4,738 articles related to study of BPH were identified. We observed a gradual increase in the number of publications from 2016 to 2022. The USA dominated the field in all countries. Shanghai Jiao Tong University was the most productive institution in 6 years. Active cooperation between countries and between institutions was not observed. Journal of Urology was the most co-cited journal. Roehrborn CG (41 papers) was the most productive author and had the largest numbers of citations (820 co-citations) during the past 6 years. Close collaboration was not observed between the different authors. The main hot topics included matters related to BPH, urinary tract symptom, prostatic urethral lift, thermal therapy, and prostatic neoplasms. This scientometric study comprehensively reviewed publications related to BPH during the past 6 years using quantitative and qualitative methods, which can be used to forecast future research developments in BPH. [ABSTRACT FROM AUTHOR]

Objective: To validate a computer version of the Danish Prostatic Symptom Score (DAN-PSS) questionnaire and compare it with the paper version. Material and methods: Ninety-three male patients (aged 25-87 years), referred to a department of urology for lower urinary tract symptoms (LUTS), filled in a personal computer (PC) version and a paper version of the DAN-PSS questionnaire. Subsequently they answered a questionnaire concerning their preferences and computer experience. Results: A fair correlation between the total scores from the paper and PC versions was found. The differences were independent of both total score and age. In the PC version all LUTS questions were answered while 9.8% were left blank in the paper version. The sexual questions were answered by 71% of patients in the paper version and by 87.5% in the PC version. For the questions in the PC version a learning curve was observed in terms of the time taken to answer the questions. Previous computer experience did not influence answering time, difference in score between paper and PC versions or total score. Almost all patients preferred the PC version to the paper version. Conclusion: The PC scores are reasonably reliable judging by comparison with previously validated traditional paper scores. The PC questionnaire had a higher response rate and was preferred by the majority of patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of the current paper is to present our study on the variability in the prostatic artery origin, discuss the less frequent origins, and present the challenges of the prostatic artery embolization (PAE) procedure, thus aiding young interventional radiologists. Materials and Methods: We studied the origins of the prostatic artery on digital subtraction angiography (DSA) examinations from PAE procedures on 35 male pelvises (70 hemi-pelvises). Results: Our study has demonstrated that the most frequent origin of the prostatic artery (PA) is the internal pudendal artery (IPA), 37.1%, followed by the anterior gluteal trunk, 27.1%, and the superior vesical artery (SVA), 21.4%. Less frequent origins are the obturator artery (OBT), 11.4%, and the inferior gluteal artery (IGA), 2.8%. Conclusions: Compared to other studies, we notice some differences in the statistical results, but the most frequent origins remain the same. What is more important for young interventional radiologists is to be aware of all the possible origins of the PA in order to be able to offer a proper treatment to their patients. The important aspect that will ensure the success of the procedure without post-procedural complications is represented by the successful embolization of the targeted prostatic parenchyma. [ABSTRACT FROM AUTHOR]

10.3390/jcm12010149 7 Sinha M.M., Pietropaolo A., Madarriaga Y.Q., de Knecht E.L., Tur A.B., Griffin S., Somani B.K. Comparison and Evaluation of Outcomes of Ureteroscopy and Stone Laser Fragmentation in Extremes of Age Groups (<=10 Years and >=80 Years of Age): A Retrospective Comparative Analysis of over 15 Years from 2 Tertiary European Centres. The last paper looked at a comparison of the safety and efficacy of laser vs. pneumatic intracorporeal lithotripsy for the treatment of bladder stones in children [[9]]. In a cohort of 31 patients, the authors conclude that the short-term preoperative discontinuation of therapy may help patients obtain a relatively safe opportunity for TURP surgery. The world of minimally invasive urology has experienced enormous growth in recent decades with technological innovations related to new techniques and equipment, better training, and the clinical adoption of translational research. [Extracted from the article]

Background There are a variety of medical and surgical treatment options available today for the management of lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Objective The aim of this paper is to highlight the various treatment options available for the management of bladder outlet obstruction secondary to BPH and discuss the benefits and potential drawbacks of each. Discussion Lifestyle and dietary modification and medical therapies, such as an alpha-1 blocker as monotherapy, should be considered as first-line when initially counselling a patient for LUTS secondary to bladder outlet obstruction due to BPH. If bothersome LUTS persist despite medical management, or if medical management is not suitable or preferable, then surgical interventions can be considered. The mainstay of surgical intervention has traditionally been transurethral resection of the prostate (TURP); however, the treatment landscape is rapidly evolving with the development of minimally invasive procedures. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) describes the non-malignant enlargement of the prostate. It is both common and growing in incidence. Treatment is multimodal, involving conservative, medical, and surgical interventions. This review aims to examine the evidence base for phytotherapies, specifically analyzing their role in treating lower urinary tract symptoms (LUTS) attributable to BPH. A literature search was completed, specifically looking for randomized control trials (RCTs) and systematic reviews involving phytotherapy treating BPH. Specific emphasis was placed on exploring substance origin, the proposed mechanism of action, evidence of efficacy, and the side-effect profile. Several phytotherapeutic agents were evaluated. These included serenoa repens, cucurbita pepo, and pygeum Africanum, among others. For most of the reviewed substances, only modest effectiveness was reported. Generally, though, all treatments were tolerated well with minimal side effects. None of the treatments discussed in this paper form part of the recommended treatment algorithm in either European or American guidelines. We, therefore, conclude that phytotherapies, in the treatment of LUTS attributable to BPH, do provide a convenient option for patients, with minimal side effects. At present, however, the evidence for the usage of phytotherapy in BPH is inconclusive, with some agents having more backing than others. This remains an expansive field of urology whereby there is still more research to be done. [ABSTRACT FROM AUTHOR]

To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80 ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel–Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required. [ABSTRACT FROM AUTHOR]

Innervation of cancerous tissue represents an important pathway enabling the nervous system to influence the processes associated with the initiation, progression, and metastasis of a neoplastic process. In the context of prostate cancer, several papers report the presence of innervation and its modulating effect on the cancer prognosis. However, most of the data are experimental, with limited information on human prostate cancer innervation. Morphometric analysis of archival prostate specimen immunohistochemistry with neural markers PGP9.5 and S100 showed a significant decrease of nerve density in the prostate cancer (n=44) compared to the normal prostate tissue (n=18) and benign prostatic hyperplasia (n=28). Sympathetic nerves were detected with TH, parasympathetic with VAChT, and sensory nerves with SP and CGRP protein detection. Dual immunofluorescence revealed numerous sympathetic nerves in normal prostate and benign prostatic hyperplasia, especially in the peripheral parts. Only a few parasympathetic nerves were found between the glands and in the peripheral parts of the prostate and benign hyperplasia. Sporadic positivity for sensory innervation was present only in approximately 1/10 of nerve fibers, especially in the larger nerves. The pattern of innervation in prostate cancer was analogous to that in normal prostate gland and benign prostatic hyperplasia but there was a significantly lower amount of all nerve types, especially in high-grade carcinoma cases. Although not significant, there was a tendency of decreasing innervation density with increasing Gleason score. Regarding the low density of nerves in prostate carcinoma, the significantly lower PCNA counts in nerves of the cancer specimens cannot be ascribed to lower proliferation activity. Our data confirmed the lower nerve density in the prostate cancer compared to the benign prostate tissue. We could not approve an increased nerve proliferation activity in prostate cancer. All nerve types, most the sympathetic, less the parasympathetic, and the sensory nerves, are present in prostate cancer. The highest nerve density at the periphery of the cancer tissue implies this to be the result of an expansive tumor growth. It is evident that the results of experimental prostate cancer models can be applied to human pathology only to a certain extent. The relation between the range of innervation and the biology of prostate cancer is very complex and will require more detailed information to be applied in therapeutic solutions. [ABSTRACT FROM AUTHOR]

Simple Summary: This paper presents six different cases of dogs treated repeatedly with deslorelin, a drug responsible for a six- or twelve-month block of the reproductive system which is registered for use in adult male dogs and ferrets, male cats and prepuberal bitches. Efficacy and safety as well as return to fertility of such non-surgical neutering methods are well known following a single use but little if any data is available on prolonged use. The dogs presented in this paper were treated for 2 to 9 consecutive years for ensuring failure to reproduce (one case) as well as for conditions which are not found on the drug leaflet (benign prostatic hypertrophy and perineal gland disease (one case each) and control of reproductive behavior in male dogs and urinary incontinence in spayed adult bitches (two cases each). All animals were in good health during treatment and presented no short-term side effects. Flare-up reactions (an increase in reproductive behavior for 1–3 weeks after treatment) were observed in 1/4 intact males and were not observed in the spayed incontinent bitches. Deslorelin was effective in all treated dogs. Fertility was immediately regained in one male dog who sired a litter when his owner forgot to come back for re-treatment at the right time. Deslorelin implants can be considered as a safe alternative to surgical castration in specific pathologies mediated by reproductive hormones in situations in which surgical castration is not an option such as animals suffering from cardiovascular conditions or other systemic diseases making anesthesia unsafe. Deslorelin is currently registered for the induction of temporary infertility in male dogs, male cats, male ferrets, and also prepubertal female dogs, but research has shown its usefulness for other conditions requiring chronic treatment. This paper presents six cases of dogs chronically treated with deslorelin for indications such as benign prostatic hyperplasia, control of fertility, abnormal reproductive behavior and urinary incontinence. All animals were in good health during treatment. Treatment duration was 2–9 years. No short-term side effects were observed except for flare-up reactions, which were observed only in 1/4 intact males. Two dogs developed a neoplasia: a spayed bitch treated for urinary incontinence developed a pituitary carcinoma, and an intact male dog implanted for control of fertility developed a bladder carcinoma. While the pituitary carcinoma seems unlikely to be related to deslorelin, the bladder carcinoma could be due to the neutered condition of the dog (which was treated for 9 years) as urinary tract neoplasia is more common in dogs following gonadectomy. Chronic treatment with deslorelin is regarded as safe when an animal is being treated for life. The possibility that a pause in the treatment might be helpful for the animal should be investigated. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a chronic, progressive disease characterized by mesenchymal cell-predominance and stromal and glandular cell-hyperproliferation. Although, the precise cause of BPH is unknown, it is believed to be associated with hormonal changes in aging men. Despite androgens and ageing are likely to play a role in the development of BPH, the pathophysiology of BPH remains uncertain. This paper aims to evaluate the diagnostic efficacy of platelet-to-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and systemic immune-inflammation index in in diagnosing BPH. A single-center-randomized-retrospective study was carried out at Alzahraa university hospital between January 2022 and November 2022 on 80 participants (40 non-BPH subjects and 40 patients with symptomatic enlarged prostate) who visited the outpatient clinic or admitted to the urology department. The BPH cases were evaluated by digital rectal examination (DRE), International Prostate Symptom Score (IPSS), prostate size, prostate specific antigen (PSA), TRUS biopsy in elevated PSA > 4 ng/ml, PLR, NLR and systemic immune inflammatory (SII). The diagnosing efficiency of the selected parameters was evaluated using Receiver Operating Characteristic (ROC) and Artificial Neural Network (ANN) showing excellent discrimination with 100% accuracy and AUC = 1 in the ROC curves. Moreover, the accuracy rate of the ANN exceeds 99%. Conclusion: PLR, NLR and SII can be significantly employed for diagnosing BPH. [ABSTRACT FROM AUTHOR]

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Purpose: Postmicturition dribbling (PMD) is a stressful symptom in middle-aged men characterized by urinary leakage after the completion of normal voiding. Appropriate treatments have not yet been introduced. This study assessed the efficacy of treatment of PMD with 75 mg udenafil daily.Materials and Methods: The study included 138 men with regular sexual lifestyles. The Hallym PMD questionnaire (HPMDQ) was used to assess PMD symptoms. After all basic examinations, patients were randomly assigned to either udenafil or placebo. Patients completed the surveys, uroflowmetry (UFM), a bladder scan, and the paper test during the follow-up visit.Results: The mean age of the patients was 57.6 years. PMD with one of every three urinations was experienced by 59 patients (42.8%), whereas 45 patients (32.6%) experienced PMD with two of every three urinations. PMD with every urination was experienced by 34 patients (24.6%). More than half of the patients (89 patients, 65.4%) indicated that persistent PMD symptoms would likely result in moderate to severe discomfort in their daily activities. As time passed, the udenafil group showed significant improvement in PMD symptoms (p = 0.001).Conclusion: Udenafil 75 mg once daily can be an effective treatment for patients with PMD symptoms. [ABSTRACT FROM AUTHOR]

Chronic prostatitis is a very common and very difficult disease. Based on the mobile medical system, this paper carried out a correlation analysis on the psychological factors and the evaluation of premature ejaculation in patients with benign prostatic hyperplasia. The article first analyzes the application in the field of mobile medical and then introduces the prostate image segmentation method based on the geometric active contour model. The emergence of automatic organ tissue segmentation technology is timely; it can help clinicians save a lot of manual segmentation time and has better reversibility and objectivity, and the theory of curve evolution is analyzed. Finally, this paper introduces the experimental research object and purpose, makes a statistical analysis of the symptoms of benign prostatic hyperplasia, and compares the incidence of psychological symptoms in patients with prostatitis under different factors. The experimental results of this paper show that 90% of prostatitis patients have mild psychological problems, and 10% have moderate psychological problems. Among them, the main reason for the psychological disorder of patients is depression, for which we should strengthen the care for patients. [ABSTRACT FROM AUTHOR]

Urine provides an ideal source for disease biomarker discovery. High-adhesion contaminants such as urobilin, which are difficult to remove from urine, can severely interfere with urinary proteomic analysis. Here, we aimed to establish a strategy based on single-pot, solid-phase-enhanced sample preparation (SP3) technology to prepare samples for urinary proteomics analysis that almost completely eliminates the impact of urobilin. A systematic evaluation of the effects of two urinary protein precipitation methods, two types of protein lysis buffers, and different ratios of magnetic digestion beads on the identification and quantification of the microscale urinary proteome was conducted. Our results indicate that methanol–chloroform precipitation, coupled with efficient lysis facilitated by urea, and subsequent enzymatic digestion using a mix of hydrophilic and hydrophobic magnetic beads offers the best performance. Further applying this strategy to the urine of patients with benign prostatic hyperplasia, prostate cancer and healthy individuals, combined with a narrow window of data-independent acquisition, FGFR4, MYLK, ORM2, GOLM1, SPP1, CD55, CSF1, DLD and TIMP3 were identified as potential biomarkers to discriminate benign prostatic hyperplasia and prostate cancer patients. [ABSTRACT FROM AUTHOR]

Simple Summary: In this review paper, we explore the role of chronic inflammation in the pathogenesis of prostatic diseases, such as chronic prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. Chronic inflammation is a significant risk factor for these diseases, but the molecular mechanisms behind it are not yet fully understood. Previous attempts to investigate, link, and target inflammatory signaling molecules in men with these conditions have been clinically ambiguous and inconclusive. As a result, we proposed a paradigm shift in which less-explored molecules in the inflammatory signaling cascade are investigated as possible therapeutic targets for prostate diseases. In addition, we comprehensively discuss how aberrant signaling of these molecules may cause prostate cancer stemness, neuroendocrine differentiation, castration resistance, metabolic reprogramming, and immunosuppression. In conclusion, we forecast that targeting the interleukin-1 receptor-associated kinases (IRAKs) signaling pathway may provide a far more effective therapeutic or prophylactic strategy for the management of chronic inflammation-driven prostatic diseases. Chronic inflammation is now recognized as one of the major risk factors and molecular hallmarks of chronic prostatitis, benign prostatic hyperplasia (BPH), and prostate tumorigenesis. However, the molecular mechanisms by which chronic inflammation signaling contributes to the pathogenesis of these prostate diseases are poorly understood. Previous efforts to therapeutically target the upstream (e.g., TLRs and IL1-Rs) and downstream (e.g., NF-κB subunits and cytokines) inflammatory signaling molecules in people with these conditions have been clinically ambiguous and unsatisfactory, hence fostering the recent paradigm shift towards unraveling and understanding the functional roles and clinical significance of the novel and relatively underexplored inflammatory molecules and pathways that could become potential therapeutic targets in managing prostatic diseases. In this review article, we exclusively discuss the causal and molecular drivers of prostatitis, BPH, and prostate tumorigenesis, as well as the potential impacts of microbiome dysbiosis and chronic inflammation in promoting prostate pathologies. We specifically focus on the importance of some of the underexplored druggable inflammatory molecules, by discussing how their aberrant signaling could promote prostate cancer (PCa) stemness, neuroendocrine differentiation, castration resistance, metabolic reprogramming, and immunosuppression. The potential contribution of the IL1R-TLR-IRAK-NF-κBs signaling molecules and NLR/inflammasomes in prostate pathologies, as well as the prospective benefits of selectively targeting the midstream molecules in the various inflammatory cascades, are also discussed. Though this review concentrates more on PCa, we envision that the information could be applied to other prostate diseases. In conclusion, we have underlined the molecular mechanisms and signaling pathways that may need to be targeted and/or further investigated to better understand the association between chronic inflammation and prostate diseases. [ABSTRACT FROM AUTHOR]

In the past two decades, thousands of documents in the field of prostatitis have been published. This bibliometric analysis aimed to assess the characteristics, hotspots and frontiers trend of global scientific output on prostatitis. With the trend of moderate growth, altogether 2,423 papers were reviewed. The leading role of the United States in global prostatitis research was obvious, while China had developed rapidly in recent years. Queen's University and JOURNAL OF UROLOGY were the most prolific affiliation and journal respectively. Nickel, J. C made the greatest contribution to the field of prostatitis. Five hotspots have been confirmed: (a) male infertility associated with prostatitis and the molecular mechanisms; (b) diagnosis and treatment of prostatitis; (c) inflammation, pain and bladder irritation symptoms; (d) relationship between chronic prostatitis/chronic pelvic pain syndrome, benign prostatic hyperplasia and prostate cancer; (e) epidemiology, complications of prostatitis and improvement of acupuncture. This bibliometric analysis reveals that the international cooperation was becoming more and more close. Hotspot analysis shows that the molecular mechanism of prostatitis will be a hotspot in the future, mainly focussing on inflammatory immunity and oxidative stress. [ABSTRACT FROM AUTHOR]

Aim: Causes of nocturia may extend beyond primary bladder pathology and it has been commonly associated as a side effect of sleep disorders. This has led to the study of melatonin and melatonin receptor agonists as a primary treatment for nocturia hypothesized to be secondary to sleep disorders. We aim to systematically review the efficacy and reported safety of melatonin and melatonin receptor agonists in the treatment of nocturia. Methods: A search strategy of EMBASE and Pubmed/Medline databases was utilized to identify eligible studies. Two thousand and twenty‐eight unique references were identified in concordance with the Preferred Reporting Items of Systematic Reviews and Meta‐Analyses guidelines for systematic reviews, of which nine papers met the inclusion criteria. The Cochrane Collaboration risk of bias criteria in the open label and nonplacebo studies was used to assess bias. Results: The nine studies identified included 3 randomized double‐blinded placebo‐controlled trials, 2 randomized non‐placebo trial, and 4 prospective open‐label trials. Three utilized the melatonin‐receptor agonist ramelteon (8 mg) and six utilized melatonin (four 2 mg extended release, two 2 mg normal release). Nocturia improved in 8 studies varying from moderate to low efficacy related to reduction in nocturia episodes. Five studies evaluated sleep parameters finding improvement in both nocturia and sleep quality. Male subjects represented 76.8% of 371 total subjects in prospective and randomized trials. Ramelteon and melatonin were both reported as well tolerated during nocturia treatment. A meta‐analysis was not able to be performed due to the heterogeneity of bladder diagnoses. Conclusions: At this time, there is insufficient evidence to routinely recommend melatonin as an effective treatment for nocturia given the limitations of current clinical studies. Randomized placebo‐controlled trials and prospective open label studies in non‐neurogenic populations report a trend towards nocturia improvement with good tolerability and rare side effects. Therefore, further larger scale randomized trials with focused urologic diagnoses in well‐characterized patient populations are warranted. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia is defined as a disorder, which has different ways of treatment depending on the symptomatology, the response to drug therapy, and the occurrence of complications. Pharmacological treatment of benign prostatic hyperplasia involves the use of mainly two groups of drugs: alpha 1 blockers and 5 alphareductase inhibitors (5ARIs). Side effects commonly occur during treatment with 5ARIs such as erectile dysfunction, decreased libido, and deterioration of psychological well-being. This paper aims to determine the association between DHEAS deficiency and the occurrence of side effects of 5ARI therapy that relate to the psychological well-being of patients with BPH. The analysis included 250 patients with benign prostatic hyperplasia (BPH), of whom 130 were treated with an alpha 1 blocker, while 120 patients were treated with a combination of tamsulosin and 5ARIs. The evaluation was conducted through questionnaires: IPSS (International Prostate Scoring System) to quantify BPH symptoms and PhQ-9 questionnaire for self-evaluation of depressive symptoms. The results showed that impaired psychological well-being occurred in 26 patients (22.5%) in the study group after 6- and 12-month therapy, which was statistically significant in this group (p<0.05). In these patients, there were also initially reduced serum values of dehydroepiandrosterone sulfate (DHEAS) (p<0.05). In this analysis, we concluded that the occurrence of impaired psychological well-being in patients treated with 5ARIs correlates with initially lower serum values of DHEAS before the start of therapy, which should be taken into account when using these medications. [ABSTRACT FROM AUTHOR]

Homeopathy remains one of the most sought after therapies for urological disorders. The aim of this paper was to systematically review the available clinical researches of homeopathy in the said conditions. Relevant trials published between Jan 1, 1981 and Dec 31, 2016 (with further extension up to Dec 31, 2017) was identified through a comprehensive search. Internal validity of the randomized trials and observational studies was assessed by The Cochrane Collaboration's tool and methodological index for non-randomized studies (MINORS) criteria respectively, homeopathic model validity by Mathie's six judgmental domains, and quality of homeopathic individualization by Saha's criteria. Four controlled (three randomized and one sequentially allocated controlled trial) trials were reviewed and 14 observational studies alongside – all demonstrated positive effect of homeopathy. Major focus areas were benign prostatic hypertrophy and renal stones. One of the four controlled trials had 'adequate' model validity, but suffered from 'high' risk of bias. None of the non-randomized studies was tagged as 'ideal' as all of those underperformed in the MINORS rating. Nine observational studies had 'adequate' model validity and quality criteria of individualization. Proof supporting individualized homeopathy from the controlled trials remained promising, still inconclusive. Although observational studies appeared to produce encouraging effects, lack of adequate quality data from randomized trials hindered to arrive at any conclusion regarding the efficacy or effectiveness of homeopathy in urological disorders. The findings from the RCTs remained scarce, underpowered and heterogeneous, had low reliability overall due to high or uncertain risk of bias and sub-standard model validity. Well-designed trials are warranted with improved methodological robustness. None; Registration web-link: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018081624&ID=CRD42018081624. [ABSTRACT FROM AUTHOR]

Objective. We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH). Methods. A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis. Results. Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC. Conclusion. B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.

Objective To systematically review the literature regarding clinical outcomes of 180- W XPS GreenLight® laser ( GL) vaporisation for the treatment of lower urinary tract symptoms ( LUTS) related to benign prostatic hyperplasia ( BPH). Methods Recent publications were identified in the field of 180- W GL vaporisation for the treatment of LUTS due to BPH. We searched for peer-reviewed original articles in the English language. Search items were: '180 W lithium triborate laser' or '180 W greenlight laser' or '180 watt lithium triborate laser' or '180 watt greenlight laser' or ' XPS greenlight laser'. In all, 30 papers published between 2012 and 2014 matched this search. Of these, 10 papers were identified dealing with consecutive cohorts of patients treated with the 180- W XPS GL Results The 10 papers included a total experience of 1640 patients. The only randomised controlled trial in this field compares 180- W with transurethral resection of the prostate ( TURP). Functional outcomes and prostate volume reduction after GL vaporisation were similar to TURP. Catheterisation time and hospital stay were shorter in patients undergoing 180 W XPS GL vaporisation (41 and 66 h vs 60 and 97 h, respectively). Four papers compared the 180- W XPS system to former GL devices showing increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180- W XPS GL offers shorter operation times than former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required. [ABSTRACT FROM AUTHOR]